Health care providers needed to help train interpreters

In 2000, Edna Gutierrez visited an East Los Angeles clinic about a lump in her breast. Suspecting breast cancer, she was referred a hospital for a biopsy, where the nurses and doctor began prepping the wrong breast.

Not understanding when Gutierrez pointed to her other breast and spoke in Spanish — including pleas for an interpreter — they took a sample from the wrong breast, which led to a “cancer free” diagnosis.

Four years later, Gutierrez returned to a doctor with sharp pains in her other breast. They discovered that she had Stage Four cancer, but, without an interpreter, she was still unable to understand the diagnoses or treatment options.

She asked her 15-year-old daughter to interpret, but the young girl was too distraught to deliver the terrible news. During the surgery consultation, Gutierrez had to call her brother, who was traveling for work. On the side of the road, he had to tell his sister that the doctors gave her a 30 percent chance of survival before surgery.

No one should have to go through what Gutierrez endured — not in a first-world country with a first-class medical system. Too many stories like this led to a landmark law two years ago that promised more equitable care for all Californians.

Senate Bill 853 mandated that, as of Jan. 1, 2009, anyone providing health insurance in California must ensure that their care providers have language services available to patients not proficient in English. But it’s questionable today whether providers and insurers are consistently and effectively following that law.

There is simply no way to monitor and enforce it, and it’s unlikely that health providers — crawling out of a recession — are making this a top priority.

It is a priority, however, as California grows and becomes more diverse. No state has more non-English speakers, yet our health workforce lacks ethnic and linguistic diversity. (According to a 2010 paper from UCLA researchers, California has 6.7 million people with limited English proficiency, yet only 31 percent of physicians speak Spanish or an Asian language.)

As Gutierrez’s story conveys, there are very real — potentially deadly — implications when medical staff and patients cannot communicate. There is confusion about diagnoses, treatment options and instructions, and patients become afraid to ask questions or even return if they don’t understand or trust medical staff.

But the answer is not one of simple interpretation. That was the de facto scenario for years at California health facilities. Family members, nearby medical staff of the same background, and even janitors have been asked to step in and explain things to patients. At best, a phone service with translators on the other line has been utilized.

The real solution is a well-trained professional who can effectively interpret medical terminology, nuance, and cultural understanding — and be a member of the in-person team counseling a patient.

Enter the Health Care Interpreter, an emerging allied health position that is bringing greater cultural competency and higher levels of care to every setting in which they work. Hundreds of these professionals already work in California, but we’ll need thousands more in the years to come.

Yet there are only six training programs at California community colleges, which have struggled to start and expand allied health programs amidst state budget cuts and uncertainty. Fortunately, some educators and health providers are forming partnerships that can serve as a model for others — and produce more workers.

City College of San Francisco’s Health Care Interpreter program — which has trained interpreters in 13 languages, from Arabic to Vietnamese — has benefited from partners such as Kaiser Permanente and San Francisco General Hospital, which have provided guest lecturers, internship sites (so that students can get real-world practice while studying), and even classroom space.

We need more employers like these to help community colleges produce the interpreters that health providers — and their patients — will need in coming years. And we need real monitoring and enforcement of SB853 to ensure that its promise is realized.

As for Edna Gutierrez, she eventually received a health care interpreter — and is alive today. For all the other Ednas in our state, we must make sure that they receive the trained medical interpreters at the beginning, not end, of their care.

<p>Nora Goodfriend-Koven is an instructor at City College of San Francisco City and serves on the board of the California Healthcare Interpreting Association.